Oyeyemi et al.

Archives of Physiotherapy (2017) 7:5

DOI 10.1186/s40945-017-0034-8

RESEARCH ARTICLE Open Access

A survey of physicians and physiotherapists

on physical activity promotion in Nigeria
Adewale L. Oyeyemi1*, Adetoyeje Y. Oyeyemi1, Rahana Y. Habib1, Rashida B. Usman1, Jasper U. Sunday1
and Zubair Usman2

Abstract
Background: Effective control of non-communicable diseases and promotion of population-wide physical activity
participation require the active engagement of health professionals. Physiotherapists and physicians, as part of their
practice, routinely screen and assess physical activity status, and recommend health enhancing physical activity
participation for their patients. This study aims to compare Nigerian physiotherapists and physicians’ knowledge of
physical activity message, role perception and confidence, perceived feasibility and barriers, and overall disposition
to promoting physical activity in their practice.
Methods: A total of 153 physicians and 94 physiotherapists recruited from 10 government hospitals in five states in
Northern Nigeria completed a standardized physical activity promotion questionnaire that elicited information on
the knowledge of physical activity, role perception and confidence, feasibility, and barriers to physical activity promotion.
Descriptive and inferential statistics were used to analyze the data.
Results: The physiotherapists and physicians were fairly knowledgeable on physical activity message (14.2 ± 2.1/20),
reported minimal or little barrier to physical activity promotion (23.7 ± 3.1/30), perceived physical activity promotion as
their role (13.0 ± 1.8/15), were confident in their ability to discuss and recommend physical activity promotion
(7.6 ± 1.6/10) and believed promoting physical activity was feasible for them (15.6 ± 2.6/20). However, over 40% of the
physiotherapists and physicians do not know the correct dosage of physical activity that could confer health benefits
to patients. The physicians showed better overall disposition to physical activity promotion than the physiotherapists
(P = 0.048), but more physiotherapists than the physicians believed ‘it is part of their role to suggest to patients to
increase their daily physical activity’ (95.7% vs 88.2%, P = 0.043) and were more ‘confident in suggesting specific
physical activity programs for their patients’ (87.2% vs 64.5%, P < 0.001).
Conclusion: Physiotherapists and physicians in Nigeria demonstrated good disposition to promoting physical
activity but many of them have knowledge deficits on the correct dosage required for better health for their
patients. These health professionals can serve as good advocates for physical activity promotion in Nigeria,
but many of them may require knowledge update on health enhancing physical activity for effective health
promotion and primary prevention of non-communicable diseases.
Keywords: Physical inactivity, Exercise, Health promotion, Health professionals, Non-communicable diseases

* Correspondence: alaoyeyemi@yahoo.com
1
Department of Physiotherapy, College of Medical Sciences, University of
Maiduguri, P.M.B 1069 Bama Road, Maiduguri, Borno State, Nigeria
Full list of author information is available at the end of the article

© The Author(s). 2017 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0
International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and
reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to
the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver
(http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Oyeyemi et al. Archives of Physiotherapy (2017) 7:5
Background
Physically active lifestyles have been shown to significantly
reduce the risk of developing cardiovascular diseases,
obesity, type 2 diabetes, several forms of cancer, dementia
and premature deaths [1–3]. It has been established that
participation in at least 150 min of moderate-intensity or
75 min of vigorous-intensity physical activity per week, or
an equivalent combination, decreases all-cause mortality
risk by 20–30% compared to insufficient physical activity
[4, 5]. Also, there is evidence that participation in
moderate-to vigorous physical activity at leisure time can
provide important health benefits compared to a seden-
tary lifestyle [6, 7]. Due to the rapidly rising prevalence of
chronic non-communicable diseases in developing coun-
tries [1, 8], it is imperative to prioritize physical activity
promotion as an important public health agenda in Afri-
can countries [9, 10].
Despite the overwhelming evidence on the benefits of
physical activity in the prevention, treatment, and re-
habilitation of major public health diseases [11–14],
physical activity levels remain low worldwide [3, 15] and
vary across populations [16]. Thus, there is a compelling
need to promote physical activity participation in the
global population [3]. In this context, policy interven-
tions that can bring about population wide change in
physical activity participation have been instituted in
many countries [3]. However to assist with policy and
programme implementation, health professionals with
requisite knowledge and expertise are required to par-
ticipate in effecting positive changes in physical activity
behavior in many developing countries [17, 18].
Traditionally, nurses, physiotherapists and physicians
are among the healthcare professionals involved in the pri-
mary prevention of non-communicable diseases or risk
reduction for these diseases. Due to their presumed
expertise on health promotion, physiotherapists and phy-
sicians are however more likely to be asked for advice or
consulted on physical activity than other healthcare pro-
fessionals [19–22]. In Australia, for example, it was recog-
nized that in getting Australians to be active, physicians
and other health care providers have to be involved in
physical activity promotion [23]. Hence, interest on the
health professionals’ awareness of physical activity guide-
lines and their disposition to promoting health enhancing
behaviors among their clients and patients has been on
the rise [24, 25].
Health professionals’ disposition to promoting physical
activity is an indirect indication of their knowledge and
understanding of the health enhancing benefits of phys-
ical activity and their role in its promotion. Some studies
show that physicians do not discuss physical activity
with majority of their patients [19, 26]. However, physi-
cians in Australia had good knowledge of the benefits of
regular physical activity and the required level for good
Page 2 of 8
health [20]. Canadians physicians reported they routinely
ask their patients about physical activity and provide
counselling [27], but they also identified lack of time as
a possible barrier to promoting physical activity among
their patients [19, 27]. Similarly, the roles of physiothera-
pists in physical activity promotion have been docu-
mented in studies among physiotherapists in Australia
[21], Germany [22], United Kingdom [28] and the
United States [29]. Given their commitment to exploit-
ing effective noninvasive interventions, physiotherapists
are considered to be in a preeminent position to pro-
mote physical activity in their practice setting and
among the general population [30, 31].
It can be argued that the disposition of physiothera-
pists and physicians to recommend physical activity is
an indication of their awareness of the menace of non-
communicable diseases and solution to mitigating these
problems. Because any advice by physiotherapists and
physicians on health promotion would likely be followed
by patients and clients [24, 25, 29–31], understanding
the disposition of these health professionals to recom-
mending health enhancing physical activity is important
to formulating strategies to improve physical activity be-
havior in the population. Since majority of the available
studies on this topic were conducted mainly in Western
high income countries, it is unclear whether the findings
from these studies can be generalized to low- and mid-
dle income- countries. Presently, no published study has
compared the disposition of physiotherapists and physi-
cians to physical activity promotion, and there is dearth
of empirical data on the knowledge and disposition of
Nigerian physiotherapists and physicians to physical ac-
tivity and health promotion recommendations. In
Nigeria, about 22% of the adults’ population do not par-
ticipate in regular physical activity to the recommended
levels (at least 150 min of moderate-intensity or 75 min
of vigorous-intensity per week) and no physical activity
surveillance system or any national plan and policy on
physical activity exists for the country [32]. Therefore,
understanding strategies to promote and improve phys-
ical activity participation in the Nigerian population is
an important priority for the country. This report com-
pared Nigerian physiotherapists and physicians’ know-
ledge, confidence, role perception, feasibility and barriers
to physical activity promotion in their practice, and their
general disposition to promoting physical activity among
their patients using a combined data from two separate
surveys of physicians and physiotherapists.
Methods
Participants, design and setting
A total of 153 physicians from two government hospitals
and 94 physiotherapists from eight government hospitals
in Nigeria were recruited as a convenience sample to
Oyeyemi et al. Archives of Physiotherapy (2017) 7:5
participate in the study. The hospitals were selected across
five states in Northern Nigeria and include University of
Maiduguri Teaching Hospital and Maiduguri Specialist
Hospital in Borno State; Federal Medical Center Yola in
Adamawa State; Murtala Mohammed Specialist Hospital
Kano, Muhammad Abdullahi Wase General Hospital
Kano, Aminu Kano Teaching Hospital, and National
Orthopedic Hospital Dala in Kano State; Federal Medical
Centre Gombe in Gombe State, and Federal Medical
Centre Birnin Kudu in Jigawa State. The response rate for
the physicians was 84.5% (153 out of 181 contacted to par-
ticipate) and 100% for the physiotherapists.
Measures and procedure
The instrument used for data collection was adapted from
a previously validated questionnaire used in a study of pri-
mary care physicians in Australia [20]. The adaptations
made to the questionnaire were minor and only aimed to
make the questionnaire also applicable to the physiothera-
pists. To ascertain the reliability of the adapted instrument
prior to the main study, its two-week test-retest reliability
was evaluated in a subsample of the participants (22 phy-
sicians and 15 physiotherapists). The reliability coefficients
(Spearman rho) of the adapted instrument were very good
(>0.90) among Nigerian physicians and physiotherapists.
The adapted questionnaire includes five subscales that
assess knowledge of physical activity messages (Knowledge,
4- items), perception of their role to promote physical ac-
tivity (role perception, 3-items), confidence in giving advice
on physical activity (confidence, 2-items), barriers to phys-
ical activity promotion (barriers, 6-items) and feasibility of
physical activity promotion strategies (feasibility, 4-items).
The survey also included a single question on ‘optimal
physical activity recommendations’ for adults with only
one correct score out of four available response options
(See Additional file 1). Possible responses to items on all
the subscales ranged from a minimum score of 1 (strongly
disagree or never or totally unfeasible) to 5 (strongly agree
or very often or highly feasible). Generally, all the five sub-
scales were computed as the mean of responses to items in
the subscale, with responses coded (or reverse-coded) such
that higher values indicated better or positive scores.
To create an overall physical activity promotion dis-
position (total composite scale) score, we summed the
participants’ responses (scores) on the five subscales and
the single question on ‘optimal physical activity recom-
mendations’. The overall disposition score ranges from a
minimum score of 20 to a maximum possible score of 100.
The higher the score, the better the disposition to physical
activity promotion among the physicians and physiothera-
pists. The term ‘disposition’ was operationally defined as
the degree of willingness or agreement to promoting phys-
ical activity. We hypothesized that physicians and physio-
therapists with better scores on knowledge, role perception,
Page 3 of 8
confidence, feasibility and perceived barriers to physical ac-
tivity promotion will be more positively disposed or willing
to promote physical activity in their practice.
Self-reported socio-demographic information such as
age, gender, and designated professional rank was also
collected from the participants. The questionnaire was
self-administered and delivered in person by two of the in-
vestigators (RBU and RYH) or through contacts who were
physiotherapists in the selected hospitals. It took about 10
to 15 min to complete the questionnaire. All participants
provided written informed consents before participating
in the study. The completed questionnaires were returned
in sealed envelopes directly to two of the investigators
(RBU and RYH) or through the contacts who either
mailed them back to researchers’ address or picked up at a
suitable time not more than four weeks following distri-
bution of the questionnaires. The study was approved by
the Research and Ethics Committee of the University of
Maiduguri Teaching Hospital, Maiduguri, Nigeria.
Statistical analyses
Descriptive statistics of mean, standard deviation and fre-
quency were used to summarize the socio-demographic
information. Independent sample t-test was utilized to de-
termine differences in summary mean scores of the know-
ledge, confidence, role perception, barriers and feasibility
of physical activity promotion subscales, and the overall
physical activity disposition score between the physiother-
apists and physicians. Health professionals’ group differ-
ences in individual items within subscales were explored
with Chi-square statistics. Differences in the subscales and
composite physical activity promotion scores by gender,
and years of working experience within the groups was
also explored at an alpha level set at p < 0.05.
Results
Socio-demographic characteristics of the participants
Participants were 247 Nigerian health professionals com-
prising 94 physiotherapists (39.1%) and 153 physicians
(61.9%). More male (n = 169, 68.4%) than female (n = 78,
31.6%) health professionals participated in the study.
Thirty-three (35.1%) of the 94 physiotherapists were
females, while 45 (29.4%) of the 153 physicians were
females. Ninety-eight of the participants (39.7%) were
aged 30 years or below, while 149 (60.3%) were above 30
years old. While majority of the physicians were older
than 30 years (77.1%), most of the physiotherapists were
30 years or younger (64.9%) (Table 1).
Knowledge, confidence and role perception on physical
activity promotion message
Comparisons of the summary scores on knowledge, confi-
dence and role perception to promoting physical activity
between the physicians and physiotherapists are shown in
Oyeyemi et al. Archives of Physiotherapy (2017) 7:5 Page 4 of 8

Table 1 Socio-demographic characteristics of the participants
Variable Physiotherapist (n = 94) Physician (n = 153)
n (%) n (%)
Gender
Male 61 (64.9) 108 (70.6)
Female 33 (35.1) 45 (29.4)
Age group
≤ 30 61 (64.9) 35 (22.9)
≤ 31 33 (34.2) 118 (77.1)
Table 2. The summary mean scores on knowledge were
13.1 ± 3.5 and 14.7 ± 2.2 for the physiotherapists and the
physicians respectively, out of the possible score of 20.
Out of the possible score of 10, the summary mean score
on confidence was 7.1 ± 1.8 for the physiotherapists and
was 7.9 ± 1.3 for the physicians. The summary mean
scores on role perception for the physiotherapists and
physicians were 13.2 ± 1.9 and 12.9 ± 1.6 respectively, out
of the possible score of 15. There was no significant differ-
ence (P > 0.05) in the knowledge, confidence and role per-
ception summary scores between the two groups.
The physicians compared to the physiotherapists tend
to score better on the knowledge item ‘Physical activity
that is good for health must make you puff and pant’
(16.3% 28.7% vs, P = 0.020) and the role perception item
‘Discussing the benefit of a physically active lifestyle is part
of my role’ (97.4% vs 91.5%, P = 0.036). However, the phys-
iotherapists tend to score better than the physicians on
the role perception item ‘Suggesting to patients ways to
increase daily physical activity is part of my role’ (95.7% vs
88.2%, P = 0.044) and on the confidence item ‘I would feel
confident in suggesting specific physical activity programs
for my patients’ (87.2% vs 64.7%, P < 0.001) (Table 3).
Physical activity promotion barriers and role feasibility
Table 2 shows the comparisons of summary scores of bar-
riers to physical activity promotion and role feasibility be-
tween the physicians and the physiotherapists. The
summary mean score on barriers for the physiotherapists
was 23.2 ± 3.6 out of a possible score of 30, while it was
Combined 24.4 ± 3.5 for the physicians. The summary mean feasibil-
n (%) ity score was 15.8 ± 2.8 out of a possible score of 20 for
the physiotherapists, while the score for the physicians
was 15.0 ± 2.5. No significant difference (P > 0.05) was ob-
169 (68.4)
served for the summary scores on barriers and role feasi-
78 (31.6)
bility between the physicians and the physiotherapists.
‘Lack of time’ was more frequently cited as a barrier to
96 (38.9) physical activity promotion by the physicians than the
151 (61.1) physiotherapists (84.3% vs 61.7%, P < 0.001). The physio-
therapists recorded better scores than the physicians on
the physical activity promotion feasibility items that fo-
cused on ‘Separate one-on-one consultation’ (70.2% vs
54.9%, P = 0.017) and ‘Group session’ (75.5% vs 57.2%, P =
0.004) as the feasible physical activity promotion strategies
for their patients (Table 3).
Differences in overall disposition to physical activity
promotion
The mean composite scores for the physicians and physio-
therapists were 78.5 ± 6.7 and 72.5 ± 7.9, respectively out
of a possible score of 100. The composite score for the
physicians was significantly better (p < 0.05) than for the
physiotherapists (Table 2). No significant difference in
knowledge, confidence, role perception, barriers and feasi-
bility of physical activity promotion by any of the demo-
graphic characteristics within the groups was found.
However, significant difference in the composite score
among physicians by gender (P < 0.05) was observed, with
male physicians having better score in overall disposition
to physical activity promotion than their female counter-
parts. No similar gender difference was observed among
the physiotherapists (not shown in table).
Optimal physical activity recommendation
Specifically when asked which physical activity prescrip-
tion they would recommend, 56.4% (n = 53) physiothera-
pists chose 30 min of moderately intense physical
activity 3-5 days per week, while only 11.7% (n = 11)
chose 15 min of moderately intense physical activity 5-6
times a week. For physicians, 90 (58.8%) respondents

Table 2 Physical activity promotion scores in overall sample and comparison between physicians and physiotherapists
Variable Combined (n = 247) Physicians (n = 153) Physiotherapists (n = 94) p-value
Knowledge 14.2 ± 2.1/20 14.7 ± 2.2/20 13.1 ± 2.2/20 0.427
Confidence 7.6 ± 1.6/10 7.9 ± 1.3/10 7.1 ± 1.8/10 0.773
Role perception 13.0 ± 1.8/15 12.9 ± 1.6/15 13.2 ± 1.9/15 0.641
Barrier 23.7 ± 3.1/30 24.4 ± 2.5/30 23.2 ± 3.6/30 0.562
Feasibility 15.6 ± 2.6/20 15.0 ± 2.5/20 15.8 ± 2.8/20 0.733
Overall disposition 75.4 ± 7.3/100 78.5 ± 6.7/100 72.5 ± 7.9/100 0.048*
Knowledge denotes knowledge of physical activity message; Role perception denotes role perception on physical activity promotion; Confidence denotes
confidence in giving physical activity message; Barriers denotes perceived barriers to physical activity promotion, Feasibility denotes feasibility of physical activity
promotion strategies and Disposition denotes overall disposition to promoting physical activity
* = Significant difference at p < 0.05
Oyeyemi et al. Archives of Physiotherapy (2017) 7:5 Page 5 of 8

Table 3 Comparison of physical activity promotion subscales items scores between physicians and physiotherapists
Variable Physicians (n = 153), n Physiotherapists (n = 94), n Chi-Square P-value
Agree (%) Agree (%)
Knowledge of PA message
Taking the stair at work and generally being more active 37 (24.3) 16 (17.0) 1.772 0.183
each day is enough physical activity to improve health
Half an hour of working on most days is all the physical 53 (34.6) 25 (26.9) 1.744 0.187
activity that is needed for good health
Physical activity that is good for health must make you 25 (16.3) 27 (28.7) 5.372 0.020*
puff and pant
Several short walks of 10 min each on most days is better 108 (70.6) 65 (69.1) 0.057 0.811
than one session of golf or soccer per week for good health
Role perception in PA promotion
Discussing the benefits of a physically active lifestyle with 149 (97.4) 86 (91.5) 4.379 0.036*
patients is part of my role
Suggesting to patients ways to increase daily physical 135 (88.2) 90 (95.7) 4.047 0.044*
activity is part of my role
I should be physically active to act as a role model for my patients 138 (90.2) 89 (94.7) 1.574 0.210
Confidence in promoting PA
I feel confident in in giving general advice to patients on physically 140 (91.5) 87 (92.6) 0.086 0.769
active lifestyle
If feel confident in suggesting specific physical activity 99 (64.7) 82 (87.2) 15.092 <0.001**
programs for my patients
Barriers to PA promotion
Lack of time 129 (84.3) 58 (61.7) 16.186 <0.001**
Lack of counselling skills 31 (20.3) 27 (28.7) 2.230 0.128
Lack of remuneration for promoting physical activity 20 (13.1) 20 (21.3) 2.888 0.089
Lack of interest in promoting physical activity 43 (28.3) 32 (34.0) 0.907 0.341
Feeling it would not change the patient’s behavior 27 (17.6) 24 (25.5) 2.209 0.137
Feeling it would not be beneficial for the patient 16 (10.5) 18 (19.1) 3.705 0.054
Feasibility of PA promotion strategies
Brief counselling integrated into your regular consultation 141 (92.2) 82 (87.2) 1.609 0.205
Separate one-on-one consultations 84 (54.9) 66 (70.2) 5.723 0.017*
Group session 88 (57.5) 71 (75.5) 8.240 0.004**
Distribution of resources (e.g., brochures) 101 (66.0) 57 (60.6) 0.730 0.393
PA Physical Activity; * = P < 0.05; ** = P < 0.01

chose 30 min of moderately intense physical activity 3-5
days per week, while only 9.8% (n = 15) chose 15 min of
moderately physical activity 5-6 days per week. No sig-
nificant difference (P = 0.679) was found between phys-
iotherapists and physicians on optimal physical activity
recommendations in terms of intensities, duration and
sessions per week (Not shown in table).
Discussion
Recommending physical activity participation is as im-
portant for overall prevention of non-communicable dis-
eases just as recommending tobacco cessation and a no
salt diet in treating hypertension [1, 2]. Generally, phys-
iotherapists and physicians are involved in the primary
prevention of non-communicable diseases and are also
involved in risk reduction for these diseases. These pro-
fessionals are also more likely than other health
personnel to be approached for advice about physical fit-
ness and physical activity by patients or clients [19–22].
Most physiotherapists and physicians in the present
study had fairly good knowledge of physical activity pro-
motional messages, perceived physical activity promo-
tion as their role, reported little barrier to physical
activity promotion on their job and believed promoting
physical activity is feasible in their practice.
The findings on this group of physicians and physio-
therapists in northern Nigeria is similar to that of Shirley
et al. [21], who observed that Australian physiotherapists
had very good knowledge, experienced little barriers and
believed promoting physical activity was feasible to them
Oyeyemi et al. Archives of Physiotherapy (2017) 7:5
in their practice. It is also consistent with the findings of
van der Ploeg et al. [20] and that of Lawlor et al. [19] which
showed that Australian and United Kingdom physicians,
respectively had very good knowledge, experienced little
barriers and believed promoting physical activity was feas-
ible to their work. Also, consistent with findings among
their colleagues in Canada [27, 33, 34], the Nigerian physi-
cians and physiotherapists in our study were confident in
giving physical activity counseling.
While the scores on knowledge, confidence, role per-
ception, barriers to physical activity promotion of physi-
cians and physiotherapists were comparable, better
disposition by the physicians than the physiotherapists
in the present study was surprising because physiothera-
pists can be expected to show better expertise and
disposition to physical activity more than the physicians
by virtue of their training focus [30, 31]. It could be that
that Nigerian physiotherapists in the present study were
more focused on the traditional clinical duty for which
they are seeing patients (e.g., low back pain, knee strain,
stroke rehabilitation, etc.), while the Nigerian physicians
tend to take a broader view of patients and therefore,
more likely to think about the overall health benefits of
physical activity than the physiotherapists. Perhaps, to
be consistent with the 21st century focus of physiother-
apy practice [30, 35, 36], the curriculum of physiother-
apy training programmes in Nigeria should be updated
to reflect contemporary knowledge and evidence on the
strategic importance of physical activity and health
promotion as effective non-invasive physiotherapy inter-
ventions for combatting the pandemic of lifestyle condi-
tions. However, there could be other potential reasons
for this surprising finding. It could be that the physicians
in our study being older have more years of professional
and practice experience that made them more disposed
to promoting physical activity in their practice than the
relatively younger physiotherapists. Since no previous
study has compared both group of health professionals
on physical activity disposition, it could be important to
explore such comparison in future studies on this topic.
However, the significantly better disposition observed
for the physicians group compared to the physiothera-
pists should be interpreted with caution. This is because
the subscales used to generate the composite disposition
score may reflect different dimensions, and may limit
the construct validity of the disposition scale. Also, the
minimally important difference for the instrument is un-
known and the higher disposition by physicians repre-
sented by only a 3-point difference, may not actually
constitute a meaningful clinical difference.
In addition to our finding that some of the health pro-
fessionals (between 21% to 31%) have poor knowledge of
physical activity messages, just over half of the physi-
cians (58.8%) and physiotherapists (56.4%) chose 30 min
Page 6 of 8
of moderate-intensity physical activity 3-5 times a week
as the optimal physical activity to be recommended to
their patients. This suggests that many of the physiother-
apists and physicians do not have optimal knowledge on
the intensity, frequency and duration of physical activity
that could confer health benefits on their patients. In-
ternational guidelines suggest that for health benefits, at
least 150 min of moderate-intensity or 75 min of
vigorous-intensity physical activity should be accumu-
lated per week [13], and this can be accumulated in
batches of 30 min per day of moderate intensity activity
for 5 days in a week [11] or 20 min per day of vigorous
intensity activity for 3 days in a week [12]. Our finding
that showed male physicians have better disposition to
physical activity promotion than their female counter-
parts was not in exact agreement with the finding in the
study of Petrella et al. [33], which showed that female
physicians make recommendations on physical activity
to their patients more frequently than their male coun-
terparts. However, absence of a significant difference
between physical activity promotion dispositions among
physiotherapists by gender as observed in the present
study is consistent with that reported in another study
of Australian physiotherapists [21].
Overall, identification of items differences between the
physiotherapists and physicians is an indication that pro-
fession specific interventions should be prioritized when
designing programs to improve physical activity dispos-
ition among physicians and physiotherapists in Nigeria.
Perhaps, improving the knowledge of intensity of phys-
ical activity for health benefits is an important deficit
that should be improved among Nigerian physiothera-
pists for effective physical activity promotion among
their patients. It seems, education and training inter-
ventions that focus on improving confidence in sug-
gesting specific physical activity programs for patients,
enhancing feasibility of separate one-on one consult-
ation and group session for physical activity promo-
tion, and eliminating the barrier of lack of time could
be most relevant areas for improvement among Nigerian
physicians.
Limitations and strength of the study
Social desirability phenomenon [37] in which the partici-
pants may have responded to the items on physical activity
promotion in ways that is perceived to be professionally
desirable could limit the results of the present study. It is
possible that the physicians and physiotherapist may have
exaggerated their perceived role, confidence, and feasibility
of promoting a physically active lifestyle among their pa-
tients. In addition, the cross-sectional study design, rela-
tively small sample size and sampling of convenience
technique utilized could limit generalization of findings to
other Nigerian physicians and physiotherapists of different
Oyeyemi et al. Archives of Physiotherapy (2017) 7:5
characteristics from the present sample. While the study
findings may be generalized to government hospitals, such
generalization may not be applicable to physicians and
physiotherapists practicing in non-government health insti-
tutions and private clinics or hospitals in Nigeria. Also, the
validity of the modified questionnaire among Nigerian
physicians and physiotherapists is unknown. The general
absence of a significant difference in the mean summary
scores for subscale variables between the two professions
should also be interpreted with caution as this could reflect
a ceiling effect resulting from the high scores reported by
both physicians and physiotherapists. A strength of
this study is that it was the first to compare the disposition
of physiotherapists and physicians to physical activity
promotion. It identified important profession-specific
deficits that could be targeted when designing effective
training programs to improve knowledge, role perception
and feasibility, and barriers to physical activity promotion
among Nigerian physiotherapists and physicians.
Conclusions
This study shows that physiotherapists and physicians in
Nigeria had fairly good knowledge of physical activity
promotion, perceived few barriers to physical activity
promotion, and reported physical activity promotion as
part of their professional role and practice area. They
were also confident in their ability to discuss and recom-
mend physical activity promotion and believed promot-
ing physical activity was feasible for them. A greater
proportion of physiotherapists than physicians believed
it is part of their role to suggest to patients to increase
their daily physical activity and were also more confident
in suggesting specific physical activity programs for their
patients, but the physicians had better overall
disposition to promoting physical activity than the phys-
iotherapists. Overall, this study shows that although
physiotherapists and physicians are positively disposed
to physical activity promotion among their patients,
some knowledge gaps exist on the recommendations for
optimum physical activity for health enhancing benefits
to patients. Nonetheless, these findings suggest that
physiotherapists and physicians can serve as good advo-
cates for optimizing outcome of physical activity promo-
tion in Nigeria. However, for effective health promotion,
prevention of non-communicable diseases and primary
health care in Nigeria, these health professionals may re-
quire some training to enhance their knowledge, confi-
dence and role feasibility in promoting health enhancing
physical activity.
Additional file
Additional file 1: Physical Activity Promotion Questionnaire. (DOC 64 kb)
Page 7 of 8
Acknowledgements
Not applicable.
Funding
No funding was received for this study.
Availability of data and materials
The dataset used and/or analysed during the current study is available from
the corresponding author on reasonable request.
Authors’ contributions
ALO participated in study design, help to conceptualize the manuscript,
conducted data analyses and interpretation of data, and drafted the manuscript.
AYO conceived and designed the study, directed its implementation, contributed
to data analyses and interpretation, and participated in drafting the manuscript.
RYB and RBU were involved with data acquisition, participated in study design
and revised the drafted manuscript. JUS and ZU contributed to data acquisition
and revised the drafted manuscript. All authors gave final approval of the version
to be published and agreed to its submission.
Competing interests
The authors declare that they have no competing interests.
Consent for publication
Not applicable because the manuscript does not include details, images, or
videos relating to individual participants.
Ethics approval and consent to participate
The study was conducted according to the guidelines laid down in the
Declaration of Helsinki and all procedures involving human subjects were
approved by the Ethics Committee of the University of Maiduguri Teaching
Hospital, (ADM/TH/EC/75). Written informed consent was obtained from all
participants. Permission was also obtained from the Chief Medical Directors
of the hospitals where the study was conducted before data collection.
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published
maps and institutional affiliations.
Author details
1
Department of Physiotherapy, College of Medical Sciences, University of
Maiduguri, P.M.B 1069 Bama Road, Maiduguri, Borno State, Nigeria. 2Faculty
of Medicine, Federal University Dutse, Dutse, Jigawa State, Nigeria.
Received: 5 January 2017 Accepted: 9 May 2017
References
1. World Health Organization. Global status report on non-communicable
diseases 2014. Geneva: WHO; 2015.
2. Lee IM, Shiroma EJ, Lobelo F, Puska P, Blair SN, Katzmarzyk PI. Effect of
physical inactivity on major non-communicable diseases worldwide: an
analysis of burden of diseases and life expectancy. Lancet. 2012;380:219–29.
3. Sallis JF, Bull FC, Guthold R, Heath GW, Inoue S, Kelly P, et al. Progress in
physical activity over the Olympic quadrennium. Lancet. 2016;388(10051):
1325–36.
4. Lee IM, Skerrett PJ. Physical activity and all-cause mortality: what is the dose
response relation? Med Sci Sports Exerc. 2001;33(6):459–71.
5. World Health organization. Global health risks: mortality and burden of
disease attributable to selected major risks. Geneva: WHO; 2009.
6. Ekelund U, Steene-Johannessen J, Brown WJ, Fagerland MW, Owen N,
Powell KE, et al. Does physical activity attenuate, or even eliminate, the
detrimental association of sitting time with mortality? A harmonised meta-
analysis of data from more than 1 million men and women. Lancet. 2016;
388(10051):1302–10.
7. Katzmarzyk PT, Church TS, Craig CL, Bouchard C. Sitting time and mortality
from all causes, cardiovascular disease and Cancer. Med Sci Sports Exerc.
2009;41(5):988–1005.
8. Abegunde DO, Mathers CD, Adam T, Ortegon M, Strong K. The burden and
costs of chronic diseases in low-income and middle-income countries. Lancet.
2007;370(9603):1929–38.
Oyeyemi et al. Archives of Physiotherapy (2017) 7:5 Page 8 of 8

9. Guthold R, Louazani SA, Riley LM, Cowan MJ, Bovet P, Damasceno A, et al. 32. Oyeyemi AL, Oyeyemi AY, Omotara BA, Akinroye KK., Lawan A, Varela AR. A
Physical activity in 22 African countries: results from WHO STEPwise glance at the Nigerian Physical Activity Country Card for Adults. Conference
approach to chronic disease risk factor surveillance. Am J Prev Med. 2011; paper presented at the 6th International Congress of Physical Activity and
41(1):52–60. Public Health (ISPAH 2016). Bangkok, Thailand; 2016.
10. Oyeyemi AL, Conway TL, Adedoyin RA, Akinroye KK, Aryeetey R, Assah F, et 33. Petrella JR, Lattanzio NC, Overend JT. Physical activity counseling and
al. Construct validity of the neighbourhood environment walkability scale prescription among Canadian primary care physicians. Arch Intern Med.
for Africa. Med Sci Sports Exerc. 2017;49(3):482–91. 2007;167(16):1774–81.
11. Pate RR, Pratt M, Blair SN, Haskell WL, Macera CA, Bouchard C, et al. Physical 34. Doyle L, Mackay-Lyons M. Utilization of aerobic exercise in adult neurological
activity and public health. A recommendation from the Center for Disease rehabilitation by physical therapists in Canada. J Neurol Phys Ther.
Control and Prevention and the American College of Sports Medicine. JAMA. 2013;37(1):20–6.
1995;273:402–7. 35. American Physical Therapy Association. Today’s physical therapist: A
12. Haskell WL, Lee I-M, Pate RP, Powell KE, Blair SN, Franklin BA, et al. Physical comprehensive review of a 21st century health care profession. 2009.
activity and public health: updated recommendation for adults from the Available at: https://www.apta.org/uploadedFiles/APTAorg/Practice_and_
American College of Sports Medicine and the American Heart Association. Patient_Care/PR_and_Marketing/Market_to_Professionals/TodaysPhysicalTherapist.
Circulation. 2007;116:1081–93. pdf. Accessed 5 April 2017.
13. World Health Organization. Global recommendations on physical activity for 36. World Confederation for Physical Therapy. Draft policy statement: Non-
health. Geneva, Switzerland: WHO Press; 2010. communicable diseases. 2014. Available at: http://www.wcpt.org/policy/ps-
14. Garber CE, Blissmer B, Deschenes MR, Franklin BA, Lamonte MJ, Lee IM, ncd. Accessed 5 April 2017.
et al. American College of Sports Medicine position stand. Quality and 37. Anastasi A. Psychological Testing. 5th ed. New York: Macmillan Publishing
quantity of exercise for developing and maintaining cardiorespiratory, Co; 1982.
musculoskeletal and neuromuscular fitness in apparently healthy adults:
Guidance for prescribing exercise. Med Sci Sports Exerc. 2011;43(7):1334–59.
15. Hallal PC, Andersen LB, Bull FC, Guthold R, Haskell W, Ekelund U. Global
physical activity levels: surveillance progress, pitfalls, and prospects. Lancet.
2012;380(9838):294–305.
16. Bauman AE, Reis RS, Sallis JF, Wells JC, Loos RJF, Martin BW. Correlates of
physical activity: Why are some people physically active and others not?
Lancet. 2012;380(9838):258–71.
17. Kohl 3rd HW, Craig CL, Lambert EV, Inoue S, Alkandari JR, Leetongin G, et al.
The pandemic of physical inactivity: global action for public health. Lancet.
2012;380(9838):294–305.
18. Reis RS, Salvo D, Ogilvie D, Lambert EV, Goenka S, Brownson RC. Scaling up
physical activity interventions worldwide: stepping up to larger and smarter
approaches to get people moving. Lancet. 2016;388(10051):1337–48.
19. Lawlor DA, Keen S, Neal RD. Increasing population levels of physical activity
through primary care: GPs’ knowledge, attitudes and self-reported practice.
Fam Pract. 1999;6:250–4.
20. van der Ploeg HP, Smith JB, Stubbs T, Vita P, Holford R, Bauman AE. Physical
activity promotion: Are GPs getting the message? Aust Fam Physician. 2007;
36(10):871–4.
21. Shirley D, Van der Ploeg HP, Bauman AE. Physical activity promotion in the
physical therapy setting: Perspectives from practitioners and students. Phys
Ther. 2010;90:1311–22.
22. Verhagen E, Engbers L. The physical therapist’s role in physical activity
promotion. Br J Sports Med. 2009;43:99–101.
23. Bauman A, Bellew B, Vita P, Brown W, Owen N. Getting Australia active:
towards better practice for the promotion of physical activity. Melbourne,
Australia: National Public Health Partnership; 2002.
24. Ribeiro MA, Martins Mde A, Carvalho CR. The role of physician counseling in
improving adherence to physical activity among the general population.
Sao Paulo Med J. 2007;125(2):115–21.
25. Eakin EG, Glasgow RE, Riley KM. Review of primary care-based physical
activity intervention studies: effectiveness and implications for practice and
future research. J Fam Pract. 2000;49(2):158–68.
26. Bull FC, Schipper EC, Jamrozik K, Blanksby BA. Beliefs and behavior of general
practitioners regarding promotion of physical activity. Aust J Public Health.
1995;19(3):300–4.
27. Kennedy MF, Meeuwisse WH. (2003): Exercise counseling by family physicians Submit your next manuscript to BioMed Central
in Canada. Prev Med. 2003;37:226–32. and we will help you at every step:
28. O’Donoghue G, Doody C, Cusack T. Physical activity and exercise promotion
and prescription in undergraduate physiotherapy education: Content analysis • We accept pre-submission inquiries
of Irish curricula. Physiotherapy. 2011;97:145–53. • Our selector tool helps you to find the most relevant journal
29. Rea BL, Hopp Marshak H, Neish C, Davis N. The role of health promotion in
• We provide round the clock customer support
physical therapy in California, New York, and Tennessee. Phys Ther. 2004;
84(6):510–23. • Convenient online submission
30. Dean E. Physical therapy in the 21st century (Part I): Toward practice informed • Thorough peer review
by epidemiology and the crisis of lifestyle conditions. Physiother Theory Pract.
• Inclusion in PubMed and all major indexing services
2009;25(5-6):330–53.
31. Dean E. Physical therapy in the 21st century (Part II): Evidence-based practice • Maximum visibility for your research
within the context of evidence-informed practice. Physiother Theory Pract.
2009;25(5-6):354–68. Submit your manuscript at
www.biomedcentral.com/submit
 Reproduced with permission of copyright owner.
Further reproduction prohibited without permission.